Evaluation of educational environment for postgraduate residents using Post Graduate Hospital Educational Environment Measure.

The objective of this study was to determine the level of educational environment among residents working in our hospital using Post graduate hospital educational environment measure (PHEEM). This cross-sectional study was conducted at services hospital, Lahore. All the Post-graduate residents (PGR's) working at Services hospital, Lahore were asked to fill a proforma having 2 parts: Bio-data and PHEEM. Out of 110 PGR's, 87 completed questionnaires, of which majority labelled education environment into level 3 (71%). Overall mean PHEEM score calculated was 90.49 ±15.44. Maximum score was found for teaching subscale followed by autonomy and social support subscale. Highest mean score was found for neurology (104) department and lowest for anaesthesia (72 ± 9.19). General surgery, internal medicine, paediatric medicine and gynaecology gave mean score of 90, 92, 93 and 89 respectively. There was non-significant difference in terms of PHEEM score when stratified for gender, year of residency and marital status.

Burnout among gynaecological residents in Lahore, Pakistan: A cross-sectional survey.

OBJECTIVE: To determine the prevalence of burnout among gynaecological residents and factors associated with it. METHODS: This cross-sectional study was performed at the University Medical and Dental College, Faisalabad, Pakistan, from March to April 2016, and comprised female medical students. Participants were divided into groups on the basis of their ABO blood groups and on body mass index criteria. Blood groups were determined by simple conventional slide method. Blood pressure was estimated by manual auscultatory technique with a mercury sphygmomanometer. Data was analysed usingSPSS20. RESULTS: Of the 102 participants, 57(55.9%) were satisfied after choosing gynaecology as career. It was found that emotional exhaustion and depersonalisation were significantly higher among residents working in government institutions than private institutions (p<0.05). Those having more than 2 years of post-graduate experience had significantly higher depersonalisation than those with lesser experience (p=0.016). Also, working for 50-60 hours/week and feeling dissatisfied with the specialty were associated with significantly higher emotional exhaustion and depersonalisation (p<0.05). CONCLUSIONS: Burnout was highly prevalent among gynaecological residents.

A Scottish multi-centre service evaluation examining the prevalence and diagnosis of Trichomonas vaginalis in symptomatic women attending sexual health clinics.

Trichomoniasis caused by the protozoan parasite Trichomonas vaginalis (TV) is one of the most commonly occurring sexually transmitted infections of non-viral origin. This study examines the prevalence of TV infection amongst consenting symptomatic women attending three of the largest sexual health clinics in Scotland, United Kingdom. In addition, an evaluation of three testing methods to identify TV from vaginal fluid was performed involving the commercial Hologic APTIMA TV transcription-mediated amplification assay, a real-time PCR assay and microscopy. A total of 398 patients consented to participation and all were tested by the three methods. The prevalence of TV was 2.8% (n = 11), with both molecular assays correctly detecting an additional two cases of TV compared to microscopy. The prevalence of three other sexually transmitted pathogens, namely Chlamydia trachomatis, Neisseria gonorrhoeae and herpes simplex virus were 7.3% (n = 31), 0.3% (n = 1) and 1.5% (n = 6), respectively. The majority of TV cases (78%; n = 8) occurred in women greater than 29 years of age compared to most Chlamydia trachomatis cases, who were aged 30 or less (97%; n = 30).

Assessment of Dengue fever severity through liver function tests.

OBJECTIVE: To assess the utility of liver function tests (LFTs) for early recognition and prediction of severity of Dengue fever in hospitalized patients. STUDY DESIGN: An analytical study. PLACE AND DURATION OF STUDY: Services Institute of Medical Science and Fatima Memorial Hospital, Lahore, from September - December 2010. METHODOLOGY: Admitted cases of Dengue fever were divided into 3 groups; mild, moderate and severe increases in aminotransferases. Elevation in LFTs was co-related with good or bad outcome i.e. (survival or complication free stay) or (death or complications). RESULTS were analyzed in SPSS version 18. RESULTS: Out of the 353 patients with mean age of 37.12 ± 15.45 years, 245 (69.4%) were males and 108 (30.6%) were females. Seventy five patients (21.2%) had mild elevation of aminotransferases (2 fold increases), 265 patients (75.1%) had moderate increases (3 to 4 fold) and 13 (3.7%) had severe (> 4 fold increase). ALT was statistically higher in patients with septicemia, hepatic and renal failure (p-value ² 0.05). AST was higher in almost all complications. Prolonged hospital stay was associated with raised LFTs and greater complications and mortality. AST was found to be twice as much raised as ALT. CONCLUSION: AST and ALT were statistically higher in patients with worse outcome thus can lead to early recognition of high risk cases.

TNF-alpha: a risk factor for ischemic stroke.

BACKGROUND: Inflammatory markers are being explored to aid in stroke diagnosis especially, to differentiate between clinical varieties of stroke. This study aimed to compare plasma tumour necrosis factor-alpha (TNF-alpha) and Interleukin-10 (IL-10) levels between stroke patients and controls, as well as between hemorrhagic and ischemic varieties of stroke. METHODS: Stroke patients who were admitted to Shaikh Zayed Hospital Lahore and Services Hospital Lahore, Pakistan within 24 hours after the onset of stroke symptoms were consecutively asked to participate in this study from June 2011 to December 2011.Venous blood samples were collected within 24 hours of stroke symptoms onset. Plasma TNF-α levels and IL-10 were calculated using commercial enzyme-linked immune-sorbent assay (ELISA). Cytokines levels were dichotomized as detectable yes/no and were compared between different groups using chi square test. Continuous variables were compared using the student t-test. Logistic regression model was used to investigate the effect of various risk factors on stroke subtypes. A value of p < 0.05 was considered significant. RESULTS: One hundred and thirty one stroke patients were included in the study, out of which 93 were ischemic and 38 were haemorrhagic stroke patients. Forty-seven healthy asymptomatic individuals were included .as controls Plasma TNF-α levels (p < 0.001, r = 0.503, CI: 18.197-1672.950) were significantly elevated in stroke patients as compared to controls, along with advancing age (p = 0.002, r = 0.310, CI: 1.025-1.110) and history of hypertension (p = 0.002, r = 0.265, CI: 1.746-12.511). Males were found to be at a higher risk of developing stroke. Furthermore, history of hypertension (p=0.019, r= -0.294, CI: 0.134-1.500) and detectable TNF- levels (p = 0.002, r = 0.319, CI: 2.106-23.725) were found to be significantly different between ischemic and haemorrhagic stroke patients. CONCLUSION: TNF-α level differed highly significantly between stroke and controls, and also between ischemic and haemorrhagic stroke subtypes.

Tibial tenderness identifies secondary hyperparathyroidism responding to high-dose vitamin D in Pakistani women.

OBJECTIVE: To assess the utility of anterior tibial tenderness (ATT) measured by visual analogue scoring (VAS) as a clinical diagnostic tool for vitamin D deficiency in a high-risk population of Pakistani women. METHODS: ATT was measured by VAS in 75 premenopausal women age 17 to 56 years (mean, 41.3 years) with generalized aches and pains and calcium <11 mg/dL (normal, 8 to 11 mg/dL) who were seen at a tertiary care center in Lahore, Pakistan. This was followed by administration of 1.8 million units of vitamin D3 in divided doses. ATT, vitamin D, and parathyroid hormone (PTH) levels were checked before and after the injections. Correlation between ATT, vitamin D, and PTH, as well as changes in ATT, vitamin D, and PTH following supplementation were determined. RESULTS: Pre-intervention average calcium and vitamin D were 9.3 mg/dL (range, 8 to 10.3 mg/dL) and 12.1 ng/mL (range, 1.5 to 32.6 ng/mL), respectively. Seventy-four percent of the participants (53/75) had vitamin D deficiency and elevated PTH (>60 pg/mL). Mean PTH was 81.6 pg/mL (range, 29.1 to 370 pg/mL). Changes in ATT correlated strongly (r = 0.422; P = .013) with changes in PTH. Following supplementation, there was significant improvement in ATT (P<.01) and vitamin D level (P<.01), with a decrease in PTH level (P<.01). CONCLUSION: ATT is a valid clinical diagnostic measure of vitamin D deficiency in South Asian women.

Recording what happens in the under-16 consultation.

BACKGROUND: Clinical staff offering sexual health services to young people need to balance the rights of the young person to confidentiality and good quality advice with the need to protect their wider interests. The needs of young clients may be complex and raise ethical and medico-legal questions for the staff involved in their care. METHODS: In our large, integrated sexual health service, a 'recording form' was introduced to prompt staff to record data systematically pertinent to consultations in clients under 16 years of age, to understand what kind of presentations dominate in these consultations, and to establish how common child protection concerns are. RESULTS: From April to October 2004, more than 500 forms were completed in our service. The age range for female clients was 12-15 years, with the median age of first sexual intercourse 14 years. Most respondents were in consensual relationships with partners of around their own age, but 10% had been in relationships of less than a week's duration. Most had not told their parents of their sexual activity and did not intend to. Child protection issues did occur, although not commonly. CONCLUSIONS: Most clients initially present requesting emergency contraception or pregnancy testing, and the inference is that unprotected sexual intercourse is common in this group of clients before they seek our services. The data collected give a valuable overview of the type of issues dealt with in the clinical context and can help to target training and teaching, in addition to potentially highlighting child protection issues.